![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Roslynn on September 26, 2012, at 15:36:57
I'm just trying to see if maybe there aren't some folks who are unable to withstand the side effects, or get unbearable/dangerous side effects (not relating to the diet.) I think I may be among those people.
Thanks,
roslynn
Posted by phillipa on September 26, 2012, at 16:05:48
In reply to Other folks who can't tolerate MAOIs???, posted by Roslynn on September 26, 2012, at 15:36:57
Some do check achieves. Phillipa
Posted by jono_in_adelaide on September 26, 2012, at 19:33:12
In reply to Re: Other folks who can't tolerate MAOIs??? » Roslynn, posted by phillipa on September 26, 2012, at 16:05:48
Not uncommon at all - the hydrazines (Narcil, Marplan) are particularly bad side effect wise, Parnate is better, so you could consider trying it.
If low blood pressure/dizziness is a problem, Florinef can be helpful
If you cant take an MAOI, you could consider an SSRI (say sertaline) combined with either bupropion or nortriptyline or desipramine or reboxetine.
Posted by ChicagoKat on September 27, 2012, at 14:45:26
In reply to Other folks who can't tolerate MAOIs???, posted by Roslynn on September 26, 2012, at 15:36:57
> I'm just trying to see if maybe there aren't some folks who are unable to withstand the side effects, or get unbearable/dangerous side effects (not relating to the diet.) I think I may be among those people.
>
> Thanks,
> roslynnHi Roslynn,
I was put on Nardil and at first it was a dream drug, it wiped out my anxiety and was helping with my depression and I was sleeping better. Then I developed ataxia (incoordination) which led to several falls out of the blue. They were definitely not a result of the postural hypotension that MAOIs can cause. So my doc took me off of it. Well, after trying everything else in the world, includine stimulants, I am now in another washout to go back on Nardil at a lower dose that we know doesn't cause the ataxia. Thanks to the help of Juno and Steve here on this board I maybe adding Nortryptiline to it so that will help with the depression. ANYWAYS, enough about me...what intolerable side effects are you/have you experienced? Maybe we can all help. I wish you the best.
Kat
Posted by Christ_empowered on September 27, 2012, at 16:54:44
In reply to Re: Other folks who can't tolerate MAOIs??? » Roslynn, posted by ChicagoKat on September 27, 2012, at 14:45:26
My doc in the past flat out rejected MAOI drugs (for me, Parnate was what I was aiming for). She said amphetamines are safer.
Posted by jono_in_adelaide on September 27, 2012, at 21:11:46
In reply to Re: Other folks who can't tolerate MAOIs???, posted by Christ_empowered on September 27, 2012, at 16:54:44
Christ - she might well be right, but thats rather like saying that Tylenol is safer than methotrexate, they are different drugs with different effects, and are far from interchangable.
Posted by Christ_empowered on September 27, 2012, at 21:29:55
In reply to Re: Other folks who can't tolerate MAOIs???, posted by Christ_empowered on September 27, 2012, at 16:54:44
In my case, she deemed adderall better for depression. faster results, and she said it was safer in terms of side effects and easier to discontinue. Given that I was looking for a "lift," I think that was a wise call.
I have no idea what you could replace Nardil with.
Posted by SLS on September 27, 2012, at 21:48:01
In reply to Re: Other folks who can't tolerate MAOIs???, posted by Christ_empowered on September 27, 2012, at 21:29:55
> In my case, she deemed adderall better for depression. faster results, and she said it was safer in terms of side effects and easier to discontinue. Given that I was looking for a "lift," I think that was a wise call.
>
> I have no idea what you could replace Nardil with.
I like Effexor 300 mg/day as an alternative to Nardil, especially when combined with Wellbutrin 300 mg/day or nortriptyline - possibly in combination with Lamictal and/or Abilify. I just wish that doctors would begin using Pristiq at dosages higher than 100 mg/day. It was deemed safe at dosages of 400 mg/day during clinical trials. Personally, I would choose Pristiq over Effexor if it were prescribed at 300 mg/day.
- Scott
Posted by jono_in_adelaide on September 27, 2012, at 22:02:54
In reply to Re: Other folks who can't tolerate MAOIs???, posted by Christ_empowered on September 27, 2012, at 21:29:55
Realy, the only substitute for Naridl is more Nardil.....I guess it would be a matter of trying other things and hoping one of them worked.
Nardils effect on GABA makes it pretty unique.
Posted by jono_in_adelaide on September 27, 2012, at 22:35:21
In reply to Re: Other folks who can't tolerate MAOIs??? » Christ_empowered, posted by SLS on September 27, 2012, at 21:48:01
Scott, yeah, I was thinking SSRI + nortriptyline/welbutrin + a low dose benzo
Posted by SLS on September 27, 2012, at 22:46:00
In reply to Re: Other folks who can't tolerate MAOIs???, posted by jono_in_adelaide on September 27, 2012, at 22:35:21
> Scott, yeah, I was thinking SSRI + nortriptyline/welbutrin + a low dose benzo
People don't seem to like Effexor anymore. I guess Zoloft or Lexapro would be good choices.Do you feel that the benzodiazepine would help compensate for the loss of Nardil's inhibition of GABA transaminase? Would you choose Klonopin first?
- Scott
Posted by jono_in_adelaide on September 27, 2012, at 23:00:19
In reply to Re: Other folks who can't tolerate MAOIs??? » jono_in_adelaide, posted by SLS on September 27, 2012, at 22:46:00
Not sure which benzo I'd try to be honest, probably somthing with a long half life so you wouldnt get the ups and down and the craving to take another pill to get through the day, in my head i was thinking Tranxene in a single bedtime dose, but to be honest, i think all benzos are much the same in equivalent doseages
Posted by ChicagoKat on September 28, 2012, at 13:08:24
In reply to Re: Other folks who can't tolerate MAOIs???, posted by jono_in_adelaide on September 27, 2012, at 23:00:19
> Not sure which benzo I'd try to be honest, probably somthing with a long half life so you wouldnt get the ups and down and the craving to take another pill to get through the day, in my head i was thinking Tranxene in a single bedtime dose, but to be honest, i think all benzos are much the same in equivalent doseages
>
>
No wonder Nardil had such a great effect on my anxiety, I had no idea. I take it none of the other MAOIs have the same effect? So if I get tolerance to Nardil I am SOL?
Posted by SLS on September 28, 2012, at 14:04:44
In reply to Re: Other folks who can't tolerate MAOIs???, posted by ChicagoKat on September 28, 2012, at 13:08:24
> > Not sure which benzo I'd try to be honest, probably somthing with a long half life so you wouldnt get the ups and down and the craving to take another pill to get through the day, in my head i was thinking Tranxene in a single bedtime dose, but to be honest, i think all benzos are much the same in equivalent doseages
> >
> >
> No wonder Nardil had such a great effect on my anxiety, I had no idea. I take it none of the other MAOIs have the same effect? So if I get tolerance to Nardil I am SOL?
This is not necessarily true. Some older studies found Parnate comparable to Nardil in treating social anxiety/phobia.I try not to exclude drugs from consideration just because I can think up some homespun theory as to why it might not work. Generally speaking, God is smarter than I am. It is sometimes better to practice clinical psychopharmacology from an empirical approach. The scientific method still works, even in the absence of a complete understanding of the mechanics involved.
Don't forget about Marplan. It is a chemical relative of Nardil, but usually milder with respect to side effects.
- Scott
Posted by jono_in_adelaide on September 28, 2012, at 18:28:48
In reply to Re: Other folks who can't tolerate MAOIs??? » ChicagoKat, posted by SLS on September 28, 2012, at 14:04:44
What makes nardil so special is that as well as being an MAO inhibitor, it inhibits the breakdown of GABA, so it can have an almost benzodiazepine like effect on anxiety.
One of its downsides is it is less potent on noradrenalin than some drugs (hence its record of being better in reactive/atypical depression than melancholic/biological depression), hence the addition of nortriptyline - the ultimate combination as it were.
Taking Vitamin B6 along with a daily multi is said to lessen some of Nardils side effects
Posted by ChicagoKat on September 28, 2012, at 21:05:30
In reply to Re: Other folks who can't tolerate MAOIs??? » ChicagoKat, posted by SLS on September 28, 2012, at 14:04:44
> > > Not sure which benzo I'd try to be honest, probably somthing with a long half life so you wouldnt get the ups and down and the craving to take another pill to get through the day, in my head i was thinking Tranxene in a single bedtime dose, but to be honest, i think all benzos are much the same in equivalent doseages
> > >
> > >
> > No wonder Nardil had such a great effect on my anxiety, I had no idea. I take it none of the other MAOIs have the same effect? So if I get tolerance to Nardil I am SOL?
>
>
> This is not necessarily true. Some older studies found Parnate comparable to Nardil in treating social anxiety/phobia.
>
> I try not to exclude drugs from consideration just because I can think up some homespun theory as to why it might not work. Generally speaking, God is smarter than I am. It is sometimes better to practice clinical psychopharmacology from an empirical approach. The scientific method still works, even in the absence of a complete understanding of the mechanics involved.
>
> Don't forget about Marplan. It is a chemical relative of Nardil, but usually milder with respect to side effects.
>
>
> - Scott
>Thanks for the info Scott. If I have bad problems with Nardil again, I will keep parnate and marplan in mind.
Kat
Posted by ChicagoKat on September 28, 2012, at 21:16:49
In reply to Re: Other folks who can't tolerate MAOIs???, posted by jono_in_adelaide on September 28, 2012, at 18:28:48
> What makes nardil so special is that as well as being an MAO inhibitor, it inhibits the breakdown of GABA, so it can have an almost benzodiazepine like effect on anxiety.
>
> One of its downsides is it is less potent on noradrenalin than some drugs (hence its record of being better in reactive/atypical depression than melancholic/biological depression), hence the addition of nortriptyline - the ultimate combination as it were.
>
> Taking Vitamin B6 along with a daily multi is said to lessen some of Nardils side effectsIt was amazing. When I went on my first washout to try an MAOI, I was up to 24mg/day of Ativan by the time the washout was done. Then we started Nardil, and within a week, I no longer needed any Ativan at all. The doc was sending me home and offered to write me a script and I said nope, I don't need it. Amazing, and no benzo withdrawal effects at all. And I think, but I'm not sure, that I fall into that reactive/atypical type of depression, so the less noradrenalin the better. I think that may be why Ritalin made me more anxious. I've thought about it, and since I am feeling better,, and I'm having good results from my therapy, I may just try the lower dose of Nardil on its own, without the addition of Nortryptiline. I know you guys have recommended it, but I am really starting to think that more noradrenaline does not do me any good. We'll see what the pdoc thinks. And I'll be sure to take a multivitamin plus some B6. Thanks so much.
Kat
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.